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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ3702114 (LAO 0873097)
Regular
Dec 08, 2016

JOE KIM vs. WORLD AUTO REPAIR CENTER, STATE COMPENSATION INSURANCE FUND

This case involves a lien claimant, Hepps Prescription Pharmacy, whose lien was dismissed by the Workers' Compensation Appeals Board (WCAB). The dismissal was based on the claimant's failure to appear at a scheduled lien conference and lack of settlement authority present. The WCAB denied the petition for reconsideration, adopting the WCJ's report and finding no good cause for the claimant's non-appearance. This decision emphasizes the importance of lien claimants attending conferences or having representatives with settlement authority present.

Workers' Compensation Appeals BoardPetition for ReconsiderationWorkers' Compensation Administrative Law JudgeLien ClaimantDismissal of Lien ClaimAppeals Board Rule 10562Good CauseHepps Prescription PharmacyState Compensation Insurance Fund
References
Case No. ADJ1968745; ADJ3771069; ADJ1711136
Regular
Aug 04, 2025

PETER WATSON vs. FPL ENERGY, BROADSPIRE SERVICES

The Workers' Compensation Appeals Board denied the Petition for Reconsideration filed by The Prescription Center Pharmacy. The petition challenged a Findings and Order from August 29, 2022, concerning the disallowance of medication charges for applicant Peter Watson. The Board applied equitable tolling to the statutory 60-day period for acting on the petition due to administrative delays in receiving the case file, ensuring a decision on the merits. The Board ultimately concluded that the petitioner failed to establish grounds for reopening discovery, willful suppression of evidence by the defendant FPL Energy, or the medical necessity for many of the disallowed medications, based on the findings of Agreed Medical Examiner Dr. Mark Hyman.

Workers' Compensation Appeals BoardPetition for ReconsiderationEquitable TollingLabor Code Section 5909Electronic Adjudication Management System (EAMS)Due ProcessSubstantial JusticeFindings and AwardPrescription Center PharmacyAdverse Inference
References
Case No. ADJ724329 (LAO 0863195)
Regular
Jan 28, 2010

BRAMBILA vs. VONS, INC.

The Workers' Compensation Appeals Board denied reconsideration to MH Express Pharmacy. The lien claimant sought additional payment for medications provided to the applicant, arguing they were prescribed by MPN physicians. However, the employer had established a Pharmacy Benefit Network (PBN) before the applicant's injury, and the lien claimant was not part of this network. The Board found the lien claimant misrepresented the record by claiming the PBN contract was not in evidence, and affirmed the denial of further payment for medications dispensed outside the PBN.

Workers' Compensation Appeals BoardLien ClaimantPharmacy Benefit NetworkMedical Provider NetworkFindings and OrderReconsiderationLabor Code section 4600.2(a)Compromise and ReleaseOfficial Medical Fee ScheduleBad Faith Tactics
References
Case No. ADJ2911649
Regular
Nov 07, 2008

MARY MIRANDA vs. WHITE MEMORIAL MEDICAL CENTER, ADVENTIST HEALTH SYSTEM / WEST

The Appeals Board granted reconsideration of a decision allowing a pharmacy's lien in full, rescinding the original order. The case is remanded to the trial level because the lien claimant failed to prove the reasonableness of its charges, as required by law. While the defendant's procedural arguments were rejected, the lack of a reasonableness finding on the lien amount necessitates further proceedings.

Workers Compensation Appeals BoardReconsiderationLien ClaimHepps PharmacyIndustrial InjuryBilateral Upper ExtremitiesCumulative TraumaCompromise and ReleaseStatute of LimitationsLabor Code Section 4903.5
References
Case No. ADJ2142052 (AHM 0149913) ADJ6592788
Regular
Mar 24, 2017

CESAREO LAGOS, vs. CAMBRO MANUFACTURING COMPANY;, ZURICH NORTH AMERICA; STATE COMPENSATION INSURANCE FUND,

The Appeals Board granted reconsideration and rescinded a $500.00 sanction order against lien claimant Asher E. Esagoff and representative Lila Ramirez. Although the WCJ found they failed to meet their burden of proof at trial, the Board determined their conduct did not rise to the level of bad faith required for Labor Code section 5813 sanctions. The Board distinguished this case from prior precedent, noting the lien claimant presented medical reports and authorization requests, even if some were excluded. Therefore, the lien claimant and representative were found not subject to the sanctions.

WCABADJ2142052ADJ6592788Cambro ManufacturingZurich North AmericaState Compensation Insurance FundLabor Code 5813sanctionslien claimantAsher Esagoff
References
Case No. ADJ7045689
Regular
Oct 21, 2011

ALDEMAR MOLINA vs. KIMCO STAFFING SERVICES, INC., SEDGWICK CMS

This case involves lien claimants seeking reconsideration of a stipulation where the applicant agreed to no industrial injury. The lien claimants argue they provided services for an industrial injury and their liens were nullified. However, the Board dismissed the petition because the lien claimants previously withdrew their liens at a hearing attended by their counsel. Therefore, the lien claimants are not currently aggrieved parties, rendering their petition moot.

Workers' Compensation Appeals BoardLien claimantsPetition for ReconsiderationStipulation and OrderNon-industrial injuryWithdrawal of liensAggrieved partyMoot issueTrial level reliefPermissibly Self-Insured
References
Case No. ADJ4449218
Regular
Mar 04, 2010

LUIS ALVARADO vs. STAFFING SERVICES, INC., STATE COMPENSATION INSURANCE FUND

Here is a summary of the case in a maximum of four sentences for a lawyer: The Workers' Compensation Appeals Board denied reconsideration of the Administrative Law Judge's (ALJ) decision, which found jurisdiction over a dispute between an injured worker's applicant and defendant Staffing Services, Inc. The ALJ correctly determined that there was no express agreement between Staffing Services and the lien claimant, Beverly Hills Pharmacy, fixing payment amounts, thus Labor Code section 5304 did not divest the Board of jurisdiction. The Board also found that removal was not appropriate for this final determination. Procedural arguments regarding a denied continuance due to the defense attorney's illness were also rejected.

Workers' Compensation Appeals BoardReconsiderationRemovalLien ClaimantExpress AgreementLabor Code Section 5304JurisdictionStaffing Services Inc.State Compensation Insurance FundBeverly Hills Pharmacy
References
Case No. ADJ240659 (MON 0358311)
Regular
Mar 25, 2009

JOHN PELLETIER vs. CVS PHARMACY, AMERICAN HOME ASSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration regarding an industrial injury to the applicant's bilateral wrists sustained while employed at CVS Pharmacy. The Board found the date of injury, for the purpose of Labor Code sections 5412 and 5500.5, was February 11, 2008, when the applicant first knew his disability was work-related and received medical confirmation. This date was subsequent to his termination, thus negating the post-termination defense under Labor Code section 3600(a)(10) due to exceptions that applied.

Workers' Compensation Appeals BoardCVS PharmacyAmerican Home AssuranceJohn Pelletiercumulative injurybilateral wristsLabor Code section 5412date of injurycompensable disabilitymedical confirmation
References
Case No. ADJ7995806
Regular
Jun 12, 2013

ROQUE NERI-HERNANDEZ vs. WORKFORCE STAFFING, TOWER GROUP COMPANIES

The Workers' Compensation Appeals Board (WCAB) granted reconsideration on its own motion regarding a prior decision that awarded applicant Roque Neri-Hernandez payment for self-procured home health care. The WCAB found that while the applicant met the burden of proof for reasonable and necessary home health care services based on a physician's prescription, further factual development was required. Issues to be clarified include the exact date the prescription was received by the defendant and the specific duration and nature of care required from the date of injury. The case was returned to the WCJ for further proceedings and a new decision.

Workers' Compensation Appeals BoardReconsiderationOpinion and OrderFindings and AwardAdministrative Law JudgePetition for ReconsiderationDecision After ReconsiderationLabor CodeSelf-procured medical careHome health care
References
Case No. ADJ7208535
Regular
Oct 09, 2014

MARIA DORAME vs. AZTEC HARVESTING, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board denied reconsideration of an order dismissing DNM Pharmacy's lien claim. The Board adopted the administrative law judge's report, finding DNM Pharmacy failed to demonstrate good cause for not appearing at the lien trial or for not objecting to the notice of intention to dismiss the lien. Additionally, the Board admonished DNM Pharmacy and its representative for failing to comply with specific rules regarding lien claimant representation. DNM Pharmacy's lien was for $2,089.06 for medication related to the applicant's psyche injury, which was dismissed as part of a Compromise and Release agreement.

Maria DorameAztec HarvestingZenith Insurance CompanyPetition for ReconsiderationOrder Denying PetitionLien ClaimantDNM PharmacyCalifornia Lien Claimant NetworkSection 10774.5Workers' Compensation Administrative Law Judge
References
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